North Carolina Coalition to End Homelessness

Name*

Oganization*

Title

Phone (xxx-xxx-xxxx)*

Email Address*

City*

1. I am currently working with homeless adults who need assistance in applying for disability.*

yes

no

1a. If no, please tell us why not:

2. Within three months after completion of SOAR training, I agree to complete at least one disability application with a client.*

yes

no

3. Please describe your experience working with people with disabilities who have applied, are applying or are currently receiving SSI/SSDI, if any.*

4. Do you have access to or a relationship with a physician or clinical psychologist in your community who may be able to conduct needed evaluations?*

yes

no

5. In order to continue to grow the SOAR project in North Carolina and provide reliable outcomes data for funders and users, I agree to provide NCCEH with data (protective filing date, length of application process and decision process, disability determination) for each disability applicant I assist.*

yes

no

I have discussed this application with my supervisor. My supervisor will support me by alllowing:*

Permission to attend the 2-day SOAR training

Ample staff time to work with clients on disability applications

Help recruiting/connecting with community partners currently engaged in SOAR

Supervisor's Email Address*

Supervisor's Name*

Are you currently a Partner Ending Homelessness in Guildford County?*

yes

no

If yes, would you like to apply for a scholarship to cover training fees, provided by Partners Ending Homlessness in Guildford County?

yes

no

SOAR Application for Greensboro Training

Applicant Information

Implementation Information

Scholarship Information